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J Appl Physiol (July 10, 2008). doi:10.1152/japplphysiol.90600.2008
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Submitted on May 1, 2008
Revised on June 30, 2008
Accepted on July 8, 2008

Arterial-Ventricular Coupling: Mechanistic Insights into Cardiovascular Performance at Rest and During Exercise

Paul David Chantler1, Edward G Lakatta2, and Samer S Najjar3*

1 NIH, NIA
2 Gerontology Research Center, National Institute on Aging, National Institutes of Health
3 National Institute on Aging

* To whom correspondence should be addressed. E-mail: najjarsa{at}mail.nih.gov.

Understanding the performance of the left ventricle requires not only examining the properties of the left ventricle itself, but also investigating the modulating effects of the arterial system on left ventricular (LV) performance. The interaction of the left ventricle with the arterial system, termed arterial-ventricular coupling, is a central determinant of cardiovascular performance and cardiac energetics. Arterial-ventricular coupling (EA/ELV) can be indexed by the ratio of effective arterial elastance (EA; a measure of the net arterial load exerted on the left ventricle) to LV end-systolic elastance (ELV; a load independent measure of LV chamber performance). At rest, in healthy individuals, EA/ELV is maintained within a narrow range, which allows the cardiovascular system to optimize energetic efficiency at the expense of mechanical efficacy. During exercise, an acute mismatch between the arterial and ventricular systems occurs, due to a disproportionate increase in ELV (from an average of 4.3 to 13.2, and 4.7 to 15.5 mmHg/ml/m2 in men and women, respectively) vs. EA (from an average of 2.3 to 3.2, and 2.3 to 2.9 mmHg/ml/m2 in men and women, respectively), to ensure that sufficient cardiac performance is achieved to meet the increased energetic requirements of the body. As a result EA/ELV decreases from an average of 0.58 to 0.34, and 0.52 to 0.27 in men and women, respectively. In this review, we provide an overview of the concept of arterial-ventricular coupling, and examine the effects of age, hypertension, and heart failure on EA/ELV and its components (EA and ELV) in men and women. We discuss these effects both at rest and during exercise, and highlight the mechanistic insights that can be derived from studying arterial-ventricular coupling.




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